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Home My WebLink About0062 ASHLEY DRIVE - Health 62 ASHLEY DR., CENTERVILLE A=172.088 UPC 12534 No. 2-153LOR HASTINGS, MN r A No.:' Fee$5 0 _00 {1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migozar *pgtem Conotruction i3ermit Application for a Permit to Construct( )Repair(x$Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 62 Ashley Drive Owner's Name,Address and Tel.No. 4 2 8-5 21 8 Assessor'sMap/Parcel Centerville MA Richard Kijak 62 Ashley Dr Centerville MA 026 2 Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service PO Box 1089 , Centerville MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching consisting of D—box, and 2/500gallon precast leaching chambers. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t 's 1]poard of Heal Signed /LLB Date `71 Application Approved by Date Application Disapproved for the following reasons Permit No. lq-8--J iT Date Isstied TOWN OF BARNSTABLE LOCATION �� h��y �� SEWAGE # �'S VU LAG ASSESSOR'S MAP & LOT/7. -Q INSTALLER'S NAME&PHONE NO. l�M �� Roh,y��c-:.`, Sr n9�c 175 - 7 7(� SEPTIC TANK CAPACITY 1 cc O' LEACHING FACILITY: (type) c, PS (size) 1 D rt 0 S X NO. OF BEDROOMS BUILDER OR OWNER k. a K.- _ PERMIT DATE: R- - —COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by _J 0 3 3c); No. Fee$50 00 I V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for 3i!5ponl *p.5tem Construction Permit Application for a Permit to Construct( )Repair(XX Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 62 Ashley Drive Owner's Name,Address and Tel.No. 428-5218 Assessor's Map/Parcel Centerville MA Richard Kijak 62 Ashley Dr Centerville MA 0261- 2 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service PO Box 1089, Centerville MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(nq Other Type of Building No. of Persons Showers Cafeteria( Other Fixtures Design ow gallons per day. Calculated daily flow gallons. Plan Da a Number of sheets Revision Date TitI6 Size'of Septic Tank Type of S.A.S. 13 t \ escrip ion of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching consisting of - D—box, and 2/500gallon precast leaching chambers. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by lodrd of Hea4hi — - gp"� 7— <7 Signed Date Application Approved by Date Application Disapproved for the following reasons I Permit No /qg Date Issued ————---———---———————---———————-----————————— THE COMMONWEALTH OF MASSACHUSETTS Kijak BARNSTABLE, MASSACHUSETTS Certificate of Compliance, THIS IS TO CERTIFY, that the On-site Sewage Disposal Sy'S'tem Construc d Repaired (x Upgraded Abandoned by at 62 Ashley Drive Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. y6n5R_ dated Installer W E Robinson Septic Sry -Designer The issuance of this permit shall not be construe as a guarantee that the system will functiop,as designed. Date Inspector —————————— ———---—————————————————————— No. a Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Kijak MiOpo0a[ *pg;tem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade Abandon System located at 62 Ashley Drive Centerville Installer: W E Robinson Septic Sry and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: K Approved by S , V i 1 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic-Syste-ins-Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated K�gp- 96, , concerning the property located at 62 Ashley Drive. Centerville, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: / i ,,�� DATE B140 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). / Y I W I' TOWN OF BARNSTABLE 4 LOCATION 6� Shl�y i�oa U& SEWAGE # VILLAGE ' cc-yy� tie ASSESSOR'S MAP & LOT/7.4 -0 F8 INSTALLER'S NAME&PHONE NO. U)fM, 1='. kohiyOSOks) SCDbc- 17S -97`7&, SEPTIC TANK CAPACITY 1,000 LEACHING FACILITY: (type) b Az� C°kA^►i*Q-S (size) JOA:)5)4 Z NO.OF BEDROOMS S BUILDER OR OWNER k% ja K PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist x, , on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ' �1 �RvN� � .0 �;' ., . . �m �� a '� � for o ; . a9` 0 o No. ....�,1... F�$........t ��dd.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .._.......).0Own...........OF.......B:r..I ZV_Ab ......-•••......--••------------•---- Apli iration for Dhipasal Works Tomitrnr#inn Vanfit Application is hereby made for a Permit to Construct ( ) or Repair (L-}-an Individual Sewage Disposal System at Le Wiz-).uc.............. o ti Addr ss /-o Lot No. l �c. .................................. _ r � . ------------------------------------ caner ' Address W '...._?.-0P..«�d,�1.C.� - l.,d.`.' .CI.L..�L �. ....__.. .. J l.�f�/ .--------•----------------------------------------- a Installer Address .Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ......................................... d -.............-----..........---------------------------------------------------------- .......... W Design Flow..........................:.................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................Width............_... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------- ------- 'Diameter..................._ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution.box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ----------- ...-------•-•----------•--...] O Description of Soil-------------------=s -- (.... - -.............................................. x x ---------------------..............................................................................-----••••-- j T--...............••---•----------------•---•---- U Nature of.Repairs or Alterations—Answer when applicable_......_.......00...��/.... � 1_�............................. ................................................................I........................................................................................................................00............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha/bee issued by the bo of liealth. Signed ,(/JJ -----•• . ...-- ... DateApplication Approved By--••----•------•-----•--•-------- -...---.........................................---- Date Application Disapproved for the following reasons:.............................•...-----•-••----•-- ---__..._....-------------------------=------....---------- ---------•......................................•----•-•----•••........--••..................------......................------------------------------•-----••---••---•---------•••------•---•---------- Date PermitNo.......:..................•-----._.-------------•---_.... Issued........................................................ Date ----------------------------------------- L"tiu&a LO CAT 10"" SEWAGE PERMIT NO. d VILLAGE INSTALLER'S NAME & ADDRESS fnC'.•m h� r6' BUILDER OR OWNER Wi-i'laJe DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 6� \ yo { f PIZ No................_....... FFz......�.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .C� :..... OF....... /C................................... Appliratiun for Diipu,sal Workii Toutitrnrtiun tirrmit Application is hereby made for a Permit to Construct ( ) or Repair (/ 4 an Individual Sewage Disposal System at: Y .............. ....".. ....... ---- ----...............ko*" o Addr s No or LotOwner A ` '" ddress Fl- ti, 1 ' °1.�01, e................................................ a Installer Address A Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................................. .....Expansion Attic ( ) Garbage Grinder ( ) } QI Other-Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) al Other fixtures ...........................: _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R: Septic Tank—Liquid capacity............gallons Length................ Width.,............... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.___-_--..-. .------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b ...................................................... Date................... S Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-------____-_-----:--._. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ...........•••-•••-• -• -----------------•--------- O Description of Soil.................... /.-" •------------------- •-._.-----•--------------.------------""------ x �" w ••------- - ••--•--•--•-••-•-------•-..... U Nature of Repairs or Alterations,—Answer when applicable............ ...., '� ----------------------------------------"--•-•--•---- -------------------------•-.......----......---.....-----------------------------------------------...---------------------------.....--------- Agreement The undersigned. agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLB 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beentissued by the boaj*of health. ` - Signed------ 'f '� . ......---- "-- .. x _ Date Application Approved By.................................. Date Application Disapproved for the following reasons:................................................................................................................ ' .---•--•.........---••-•••-•...-•••---•••-••--•-••-•--•••--•-•...._.•--•----••••-•-•---------------------•------------•---••-•----••---------•-•----•-----••-•-------.................................. Date PermitNo......................................................... Issued-............................................ Date �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH, ...............1.461 .J.7....OF..... ........................ (9rrtif iratr of f omplittnrr ' THIS.IS C RTIFY That he Individual Sewage,Dis Disposal System constructed ( ) or Repaired ( L}— by. - ;...oil . has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM L F NC TION SATISFACTORY. DATE.-/O-O. R ---•--•..............."---------..."-"-•----......... . -•------"-"---.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j d...........OF........ FEE-":?':/..ti./J ` �i��ruuttl Turku �un�tr�rtiun rrntit Permission is hereby" granted...... ._ .___ ._ e a ,.-r � to Construct ) or Rep it ( L LIndividual eve ge D's sal S em ` Street as shown on the application for Disposal Works Construction Permit No...................... Dated.......................................... Board of Health DATE-----"----------------------------------•-----•-". .:...--------•-........._... FORM 1255 A. M. SULKIN,-INC., BOSTON